First aid supplies and many over-the-counter medications are available in the health center and can be administered by
Health Staff or designated First Aider via parent/guardian approval and the written health care plan. Please indicate which
over-the-counter medications and preparations may be dispensed to your daughter on an as-needed basis.
Camper Name: Session:
All medications (prescription, over-the counter and vitamins/supplements) must be in their original packaging. Medications must not be
expired. Camp Health Staff cannot accept medications in unlabeled pill boxes or bags. All medications (prescription, over-the counter and
vitamins/supplements) will be turned in to Health Staff during check-in and will be kept in the Health Center for the duration of the camp
session. Place medications together in a clear plastic bag with your camper’s name on it. Any medications that must be carried at all times
(e.g. inhalers or insect sting kits) must be accompanied by written authorization from a physician stating this requirement.
Name of Medication (Drug) Amount to be Given (Dosage) Times to be Given
Example: Claritin, 5 mg tablet 1 tablet (5 mg) At breakfast
My daughter will not be bringing any medication to camp.
✓
Name of Medication (Drug)
Initials
Acetaminophen (Tylenol)
Ibuprofen (Advil)
Sunburn Preparation
Indigestion/Diarrhea Medication
Earache Medication
Sore Throat Medication
Cold/Cough/Allergy Medication
Calamine/Caladryl
Benadryl
Skin Cleansing Agent
Topical Antibiotic
Eye/Ear Irrigation Solution
Special Instructions:
Parent/Guardian’s Signature: Date:
Camp Health Staff Signature: Date:
(if medication belongs to camper or employeee under the age of 18)
BP/sa C-248
2021
2021 RESIDENT CAMPER MEDICATION FORM
Due May 1 for June camps Due June 1 for all other camps
This form is required for all campers.
Questions? Call our Answer Center at 314.400.4600
Return To:
Email: camperforms@girlscoutsem.org Fax: 314.214.3068
Mail: Girl Scouts of Eastern Missouri
Camp Department
2300 Ball Drive
St. Louis, MO 63146
Medications Available at Camp
